Olgun ERDEM, Tolga CANBAK, Aylin ACAR, Sevde Nur EMİR, Hüsna TOSUN, Görkem KARAMUSTAFAO, Fatih BAŞAK
İstanbul Medical Journal - 2026;27(3):259-267
Introduction: Body composition abnormalities, including sarcopenia and adipose tissue alterations, have emerged as potential prognostic biomarkers in pancreatic ductal adenocarcinoma (PDAC). The present study investigated the relationship between preoperative computed tomography (CT)-derived adipose and muscle parameters and survival outcomes in patients undergoing pancreaticoduodenectomy for PDAC. Methods: This retrospective analysis enrolled 69 patients with histologically confirmed PDAC who underwent pancreaticoduodenectomy between 2018 and 2024. Preoperative contrast-enhanced CT images acquired within 30 days before surgery were assessed at the level of the third lumbar vertebra (L3). Measurements included the area and attenuation of visceral and subcutaneous adipose tissue, as well as the area and attenuation of the psoas muscle. Overall survival (OS) and disease-free survival (DFS) were evaluated using Kaplan-Meier survival curves and Cox proportional hazards models. Results: Median OS and DFS were 10.0 and 7.0 months, respectively. Kaplan-Meier analyses showed no statistically significant differences in survival across body composition parameters (all p>0.05), although several parameters exhibited consistent numerical trends in survival. In multivariable analysis, higher T stage was independently associated with worse OS [hazard ratio (HR): 1.83, 95% confidence interval (CI): 1.12-3.00, p=0.015], whereas adjuvant chemotherapy remained independently associated with improved OS (HR: 0.16, 95% CI: 0.07-0.34, p<0.001). Because of the limited number of DFS events, multivariable analysis was not performed. Conclusion: CT-derived body composition analysis may provide complementary prognostic information in patients undergoing pancreaticoduodenectomy for PDAC. Although independent associations were not consistently demonstrated, the observed survival patterns support further investigation of CT-derived muscle and adipose tissue parameters as potential imaging biomarkers. Larger prospective multicenter studies are warranted to clarify their prognostic value.
